title: Hepatic steatosis and insulin resistance are associated with severe fibrosis in patients with chronic hepatitis caused by HBV or HCV infection.
abstract: OBJECTIVE
  Steatosis and insulin resistance (IR) are the major disease modifying in patients with chronic hepatitis C (CHC). Only few studies evaluated these features in patients with chronic hepatitis B (CHB). We aimed to assess the prevalence and the factors related to steatosis and IR in CHB patients, compared with CHC subjects, and to evaluate the potential association between these features and fibrosis severity.
  
  
  METHODS
  One hundred and seventy consecutive patients with CHB (28 HBeAg positive, 142 HBeAg negative), were evaluated using liver biopsy and metabolic measurements and matched for sex, age and body mass index with 170 genotype 1 CHC patients. IR was defined if HOMA-IR>2.7. All biopsies were scored for grading and staging by Scheuer's score, and the steatosis was considered significant if ≥ 10%.
  
  
  RESULTS
  The prevalence of significant steatosis was similar in both CHB and CHC patients (31 vs. 38%; P=0.14). IR rate was significantly higher in CHC than in CHB patients (42 vs. 26%; P=0.002). Severe fibrosis (F3-F4), at multivariate analysis, was independently associated with older age (OR 1.050, 95% CI 1.009-1.093), steatosis >10% (OR 4.375, 95% CI 1.749-10.943), and moderate-severe necroinflammatory activity (OR 8.187, 95% CI 2.103-31.875), regardless of HBeAg status, in CHB patients, and with older age (OR 1.080, 95% CI 1.028-1.136), IR (OR 2.640, 95% CI 1.110-6.281), steatosis >10% (OR 3.375, 95% CI 1.394-8.171), and moderate-severe necroinflammatory activity (OR 8.988, 95% CI 1.853-43.593) in CHC patients.
  
  
  CONCLUSIONS
  CHB patients had high steatosis prevalence, similar to CHC controls, but lower IR rate. Both steatosis and IR in CHC, and only steatosis in CHB, are independently associated with fibrosis severity.
authors.affiliation: Sezione di Gastroenterologia, University of Palermo, Palermo, Italy. petsa@inwind.it
authors.forename: Salvatore
authors.initials: S
authors.lastname: Petta
authors.forename: Calogero
authors.initials: C
authors.lastname: Cammà
authors.forename: Vito
authors.initials: V
authors.lastname: Di Marco
authors.forename: Fabio Salvatore
authors.initials: FS
authors.lastname: Macaluso
authors.forename: Marcello
authors.initials: M
authors.lastname: Maida
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pizzolanti
authors.forename: Beatrice
authors.initials: B
authors.lastname: Belmonte
authors.forename: Daniela
authors.initials: D
authors.lastname: Cabibi
authors.forename: Rosa
authors.initials: R
authors.lastname: Di Stefano
authors.forename: Donatella
authors.initials: D
authors.lastname: Ferraro
authors.forename: Carla
authors.initials: C
authors.lastname: Guarnotta
authors.forename: Giovanna
authors.initials: G
authors.lastname: Venezia
authors.forename: Antonio
authors.initials: A
authors.lastname: Craxì
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001706:Biopsy; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D004797:Enzyme-Linked Immunosorbent Assay; D005234:Fatty Liver / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006510:Hepatitis B Antibodies / Q000097:blood; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D007118:Immunoassay; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007558:Italy / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology*; D008297:Male; D015995:Prevalence; D012044:Regression Analysis; D014280:Triglycerides / Q000097:blood
chemical_list: D001786:Blood Glucose; D006510:Hepatitis B Antibodies; D007328:Insulin; D014280:Triglycerides; D000410:Alanine Transaminase